Dr Ekwaro Obuku, the president of the Uganda Medical Association, has said the medical workers' sit-down strike couldn't have come at a better time than when the government is trying to sell to the public the age limit removal bill. He spoke to Baker Batte Lule on Monday, November 13. Excerpts:-
Why did you call for this industrial action now?
The last time doctors called a nationwide industrial action was 20 years ago in 1996 and it led to the birth of the Uganda Medical Workers’ Union.
We have been engaging the state back and forth and salaries have improved from Shs 150,000 to Shs 1 million but that is not commensurate with the inflation.
Last year we presented a paper, the Mungherera petition on duty facilitation allowance to parliament to consider. We thought that they would look into it but they didn’t; so, there was a build-up of frustration and despair over the years.
Look at the public service evaluation report of 2000. If you look at the single-spine structure option, the doctor is placed at the top but other bureaucrats below the doctor are paid more.
All these beautiful structures built by the government are appreciated but the supply of the medicine is chronically inadequate. Some patients can buy for themselves drugs, others can’t. But blood and oxygen are not something you can buy from a shop or pharmacy; these depend on the efficiency of the health system.
So, if the system can’t manage the supply, that is why Uganda falls under the highly fragile state index where the government is not able to provide basic social services to its people.
The precipitator of the strike was the wanton arrest of doctors by the State House Health Monitoring Unit (HMU). This continuing harassment of doctors from parallel units, yet there are professional bodies established by law such as the Uganda Medical and Dental Council, is what we are resisting. The third reason had to do with working conditions of health workers; salary, housing and others.
Does this mean HMU arrests doctors anyhow or there is something with doctors that also needs to be sorted out?
What we are saying is doctors are human and come from the same community. Definitely, we have our bad apples but we have a professional way of handling it.
We are mainly focusing on professional malpractice. We are not talking about doctors who do deals on drugs. Those we have no problem holding them accountable. We are talking about a mother dying and something comes up that you are unprofessional.
That’s why the medical and dental council was established; to sort out professional misconduct but this parallel unit does not discriminate. It handles us as if we are petty criminals; people’s names have been spoilt.
When you say you have a problem with HMU, why don’t you challenge its legality?
We agree in principle that there should be firm monitoring of health services to ensure a return on investment of taxpayers’ money.
What is being done is a disincentive to an already disinterested doctor. The approach of the HMU is the wrong one. No one wants drugs stolen; we are saying corruption should be fought upstream first because that’s where you are most likely to make gains because hospitals are signing for drugs they don’t receive.
People agree that your salaries should be increased but say your demands are preposterous.
Common sense will tell you that if you are bargaining; name your best price, then you can work it down. Most importantly, it is informed by research. We have done research in Africa in comparable economies.
Where the economies are stronger, we have done research to adjust for GDP so much that you cannot argue that because Kenya has a bigger economy they pay better. We know that Kenya’s economy is nearly three times that of Uganda. The purchasing power parity is $1,500 per capita but Uganda’s is about $600.
But when you adjust the salary of a senior consultant in Uganda and that of Kenya, you find a big disparity that’s why our doctors have moved to Kenya, Tanzania, Rwanda, South Africa and South Sudan for better working conditions.
You can’t imagine that a beginning doctor is paid the same salary like a cook at Makerere University. Shs 3.5 million earned by a medical consultant is the same salary a teaching assistant gets at Makerere. Parliament, cabinet and all these statutory institutions have private health insurance schemes but they allow the rest of Ugandans to suffer. This inequity is what we are talking about.
We are talking about 430 MPs vis-a-vis 1,300 doctors…
Our strategy in this industrial action is informed by historical accounts and research. One of the researches that we did was to compare the earnings and the wage bills.
We looked at the wage bill of parliament; it was Shs 200 billion. The additional Shs 100 billion we are asking for is only to cover 1,300 doctors, not even at their market rates.
The other one I said is a road map to Vision 2040. If you look at the work that MPs do and their qualifications, the value in society, you will know that we can’t exist without people to treat us. Society can exist without a parliament, we can have a dictator who is benevolent. We can abolish parliament, but you can’t do away with somebody who is going to treat you.
Doctors make a direct contribution to the economy but what has parliament done to improve productivity of the health sector?
Uganda’s poverty index has increased from about 17 percent to about 27 percent since the recent few years and here we are investing more in politics instead of the people.
When you speak of MPs’ salaries, fragile state etc, you come off more as a politician …
Ben Carson, a former Republican US presidential candidate, wrote: “I believe it is a very good idea for physicians, scientists, engineers and others trained to make decisions based on facts and empirical data to get involved in the political arena. You know you send a thief to catch a thief…I have the advantage of entering a political science class in my health policy PhD class.
I know very well that social services delivery is a political problem, political question and a political solution. Let’s look at Cuba; a country with relatively low income, socialist-communist ideals, focuses on the masses, less capitalist, has one of the best and strongest health systems, the quality of life as reflected by the life expectancy which is even higher than many of the rich countries.
The US; capitalist and much more developed than Cuba, people are dying; the life expectancy is not as good as that of Cuba, the health system is very expensive because in capitalism, it is a man-eat-man situation; you don’t have money, you die.”
So, the politics and the type of health system are very important. Political commitment is very important without which you cannot finance the health sector; you cannot hire the right human resource, you cannot strengthen the supply chain.
The issue of talking politics is really talking the language that people who make the decisions can understand. You have to put it in such a way that the president realises that more social services delivery means more votes.
When the president is moving around, he promises a health centre, a hospital or a school. That’s why we can’t separate politics from health services. When Dr Kizza Besigye went to Abim hospital, it was exposed and that’s when it was rehabilitated. Politics is about service delivery. That’s why it is political.
I’m merely a loud speaker…They elected me overwhelmingly to talk for them. I’m the messenger.
Some people have questioned the timing of your industrial action, you lay down tools when the government is at its weakest trying to market a proposal that seems to be unpopular...
We promised when we were being elected that we will play the big boy’s league which is played at the political level. Our strategy is informed by research, by political science frameworks of setting the agenda.
When you are setting the agenda, the politics, the problem and the people, need to meet. The problem has been chronic and the people have organised themselves. The doctors have provided the leadership and Ugandans have supported them saying this is a problem that needs attention.
So far we are happy that we chose this time, it couldn’t have been better. We have been having negotiations with government; they have listened to us briefly and have shelved the issue. This time we are saying; can we conclude this discussion?
You are leading a campaign for better working conditions in government health centres but you don’t work in a government hospital…
It is true I have not worked in a public hospital for a long time but I can tell you I have used public hospitals. Very recently, my children have been born in public hospitals, my relatives use public hospitals. But most of all I contribute taxes to these public hospitals. My members of the Uganda Medical Association work in public hospitals and I visit them.
I supervised HIV programmes, worked with the ministry of health providing technical service provisions in public hospitals. I do consultancies in public hospitals. Therefore, I’m more public than many think.
How do you react to minister of health Jane Ruth Aceng’s claim that UMA is an illegal entity?
Ugandans can interpret for themselves. The minister was ill-advised because the Uganda Medical Association broke away from the British Medical Association in 1964.
So, UMA is older than even the NRM party she belongs to. We were registered in 1974 as a public entity. In 2005, we registered as a company limited by guarantee. So, we are legal. We have those papers; they are public and the government keeps them for us.
Secondly we are legitimate; we have a membership that is credible including the minister herself [and], the former minister Dr Christine Ondoa. The permanent secretary, Dr Diana Atwine is a strong member.
Other high-profile government officials like Dr Ruhakana Rugunda, Dr Chris Baryomunsi, Dr Mike Bukenya, the chair of the parliamentary committee on health; Prof. Francis Omaswa, Dr Speciosa Kazibwe all these are members and they pay their membership fees promptly.
What is the way forward out of this?
The way forward is negotiations. There are international principles that describe the arrangement of comprehensive collective bargaining. What we want from government is a signed collective bargaining agreement which we will use as a point of reference for what is due to Uganda Medical Association.
Some things cannot wait like the supplementary budget for drugs. The second thing that cannot wait are the administrative issues, like establishing that position of an intern doctor and senior house officer in the public service. Put them in the public service structure and pay them according to the agreed salary scale.